What is the role of nutritional counseling in CKD?
Compared with the general population, nutritional interventions in patients with CKD and especially those undergoing maintenance hemodialysis therapy are more complex.
The most basic intervention is dietary counseling, the goals of which are aimed on the one hand to provide the necessary amount of energy, protein, and other nutrients and on the other hand to avoid biochemical imbalances that are the result of the lack of kidney function.
These two goals of dietary intervention are often in conflict with each other, as for example, adequate amounts of protein in diet will result in an obligatory intake of potassium and phosphorus and could lead to hyperkalemia and/or hyperphosphatemia.
Dietary counseling is even more complex in patients with CKD, in whom protein restriction of 0.6 to 0.8 g/kg per day has been suggested as an intervention to retard progression of kidney disease, but in whom restrictions of this magnitude may result in unintended worsening in their nutritional status. Because of this complexity, nutritional management (including formal assessment of nutritional status and formal nutritional interventions) should be provided by trained nutritionists to ensure the adequacy of the nutritional value of any imposed restricted diets.
